ModifiedCignaPolicy 0515

Miscellaneous Musculoskeletal Procedures

Cigna's coverage policy for various musculoskeletal procedures (articular cartilage repair outside the knee, ligament/meniscus reconstruction adjuncts, intra-articular injections, thermal capsular procedures, and other miscellaneous procedures) and applicability to Cigna-administered health benefit plans and providers.

Policy Summary

PayerCigna

PolicyMiscellaneous Musculoskeletal Procedures

Policy CodePolicy 0515

Change TypeMaterial revisions (2024–2025): added thermal shrinkage & MISHArevised healing responseremoved several prior statements

Effective Date

Next Review DateApr 15, 2025

Key ActionObtain prior authorization when requesting osteochondral allograft/autograft of the talus or for investigational/emerging procedures to ensure medical necessity and appropriate patient selection.

SourceLink

POLICY UPDATE CHANGES

Revised policy statement for healing response microfracture technique.

Removed policy statement for subacromial balloon spacer.

Added policy statement for thermal shrinkage.

Added policy statement for medial knee implanted shock absorber.

Removed statements for focal resurfacing of knee joint and allograft bone substitutes for isolated facet fusion.

multipleprocedures addressed

4max steroid injections /12mo

Trek Health ingests and normalizes Transparency in Coverage data and payer policy updates to give provider organizations a clear view of how commercial reimbursement behaves across markets, payers, and services. Our platform transforms raw payer disclosures into structured intelligence that supports contract evaluation, payer negotiations, and service line strategy. By combining market benchmarks with ongoing policy visibility, Trek helps teams identify variability, risk, and opportunity in commercial reimbursement. The result is faster insight, stronger negotiating positions, and more informed financial decisions.

max steroid injections same day

72%decellularized allograft failure (2yr)

42%talus allograft reoperation % (example)

4/15/2025most recent review

Coverage Determinations

inv-01: Articular Cartilage Repair (non-knee) — Not medically necessary for articular cartilage defects in joints other than the knee

Articular Cartilage Repair Each of the following procedures is considered not medically necessary for treatment of articular cartilage defects involving joints other than the distal femur and patellar articular cartilage within the knee (e.g., ankle, elbow, shoulder):

autologous chondrocyte implantation (e.g., Carticel®, MACI® [Vericel Corporation, Cambridge, MA])

osteochondral allograft transplantation

osteochondral autograft transplantation

inv-02: Experimental / Investigational Procedures — list of procedures considered experimental, investigational, or unproven

Articular cartilage repair using ANY of the following, for any joint, is considered experimental, investigational or unproven:

cartilage regeneration membrane (e.g., Chondro-Gide®)

xenograft implantation into the articular surface

synthetic resorbable polymers (e.g., PolyGraft™ BGS, TruFit® [cylindrical plug], TruGraft™ [granules])

juvenile cartilage allograft tissue implantation, including minced cartilage (e.g., DeNovo® NT Natural Tissue Graft, DeNovo® ET™ Engineered Tissue Graft; BioCartilage®)

decellularized osteochondral allograft implant (e.g., Chondrofix® Osteochondral Allograft)

inv-03: Ligament Allograft — Medically necessary when indicated

Ligament/Meniscus Reconstruction Ligament allograft materials are considered medically necessary when medical necessity has been established for the associated primary procedure.

Example: anterior cruciate ligament allograft

inv-04: Intra-articular Corticosteroid Injection Limits — Coverage limits and frequency constraints

Intra-articular corticosteroid injections for the treatment of chronic, osteoarthritic joint pain are not covered or reimbursable when administered more frequently than either of the following:

four injections during a rolling 12 month year

two injections on the same day

inv-05: Healing Response Technique — Not medically necessary

Healing response microfracture technique for treatment of intra-articular ligament injury is considered not medically necessary due to insufficient evidence of safety and efficacy.

Healing response microfracture technique (e.g., biologic healing response)

inv-10: Subchondroplasty — investigational / insufficient evidence

Subchondroplasty for the treatment of a subchondral bone defect is considered experimental, investigational or unproven.

Subchondroplasty (injection of bone void filler into subchondral bone defect)

inv-11: Percutaneous ultrasonic ablation — limited evidence

Percutaneous ablation of soft tissue for treatment of any musculoskeletal condition (e.g., tendinosis, tendinopathy) is considered experimental, investigational or unproven.

Percutaneous ultrasonic ablation / tenotomy (e.g., Tenex Health TX System®)

inv-12: In-office arthroscopy — limited evidence

In-office diagnostic arthroscopy of any upper or lower extremity joint for evaluation of joint pain and/or pathology is considered experimental, investigational or unproven.

In-office needle arthroscopy systems (e.g., Mi-Eye2™, VisionScope®)

inv-13: MISHA — limited peer-reviewed evidence despite FDA De Novo

Medial knee implanted shock absorber (e.g., MISHA™ Knee System) is considered experimental, investigational or unproven for any indication, including management of osteoarthritis.

MISHA™ Knee System (medial knee extraarticular implantable shock absorber)

inv-14: Thermal shrinkage — not supported by robust evidence / high failure rates

Thermal shrinkage (arthroscopic thermal capsulorrhaphy, electrothermal arthroscopic capsulorrhaphy, radiofrequency thermal shrinkage) is considered experimental, investigational or unproven for treatment of joint capsule, ligament, or tendon conditions.

Thermal capsulorrhaphy / thermal shrinkage for shoulder, knee (ACL/PCL), ankle, hip, hand/wrist

inv-15: Thermal shrinkage — evidence-based conclusion and coverage stance

Thermal shrinkage procedures have demonstrated high failure rates in some series and insufficient long-term durability; therefore thermal shrinkage is considered not medically necessary or experimental depending on the indication.

Thermal shrinkage with arthroscopy codes and unlisted procedure coding

inv-16: Coverage determinations for related procedures/materials — coverage designations

Coverage determinations for related procedures and materials: codes and status summaries are provided below.

Osteochondral allograft of talus may be considered when criteria met; literature shows mixed outcomes compared to autograft and insufficient evidence for joints other than knee.

Decellularized cartilage (e.g., Chondrofix®) and synthetic polymers have limited/poor outcomes in some reports and are considered unproven.

A variety of procedures (meniscal scaffolds, subchondroplasty, ultrasonic ablation, in-office arthroscopy, MISHA, thermal shrinkage) have limited evidence and are considered experimental or investigational.

Note: J7330 and L8699 are considered Experimental/Investigational/Unproven when used to report xenograft implant and cartilage regeneration membrane products for articular cartilage repair.

Considered Experimental/Investigational/Unproven when used to report articular cartilage repair of any joint: 0737T = Xenograft implantation into the articular surface.

These materials (e.g., PolyGraft BGS, TruFit, TruGraft, DeNovo NT/ET, BioCartilage, Chondrofix) lack sufficient high-quality evidence to support routine use for articular cartilage repair outside of investigational settings.

Note: Ligament allograft materials are considered medically necessary when medical necessity has been established for the associated primary procedure. Menaflex™ had 510(k) clearance rescinded by the FDA; Actifit® has received Breakthrough Designation but lacks full FDA approval.

Healing response technique (code 29999) is explicitly listed as not medically necessary for this policy.

Subchondroplasty codes are listed as experimental/investigational/unproven for any joint due to insufficient evidence and lack of long-term outcome data.

In-office diagnostic arthroscopy systems are considered experimental/investigational due to limited peer-reviewed evidence demonstrating impact on health outcomes.

Percutaneous ultrasonic ablation codes are listed as experimental/investigational/unproven because current literature is limited to small case series and lacks high-quality comparative trials.

Although the MISHA system received FDA De Novo authorization, peer-reviewed clinical evidence is limited and does not yet demonstrate improved net health outcomes; therefore use is considered experimental/investigational/unproven.

Thermal capsulorrhaphy and related thermal procedures are considered experimental/investigational/unproven given inconsistent evidence, high failure rates in some series, and safety concerns.

Coding and Billing Guidance

Regulatory/Device Codes Mentionedmixed

510(k)

FDA marketing clearance pathway referenced for PolyGraft BGS

Thermal shrinkage / Unlisted arthroscopyCPT | HCPCS

29999	Unlisted procedure, arthroscopy
S2300	Thermal shrinkage (thermally induced capsulorrhaphy) — listed as application code

Unlisted/Experimental CPT/HCPCS/Therapy codes referencedmixed

23929	Unlisted procedure, shoulder
24999	Unlisted procedure, humerus or elbow
27299	Unlisted procedure, pelvis or hip joint
27599	Unlisted procedure, femur or knee
27899	Unlisted procedure, leg or ankle
28446	Open osteochondral autograft, talus (includes obtaining graft[s])
28899	Unlisted procedure, foot or toes
0707T	Injection(s), bone-substitute material into subchondral bone defect, including imaging guidance and arthroscopic assistance
0869T	Injection(s), bone-substitute material for bone and/or soft tissue hardware fixation augmentation, including intraoperative imaging guidance
0737T	Xenograft implantation into the articular surface

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Subchondroplasty-related codesCPT|HCPCSNot Covered

23929	Unlisted procedure, shoulder
27299	Unlisted procedure, pelvis or hip joint
27599	Unlisted procedure, femur or knee
27899	Unlisted procedure, leg or ankle
28899	Unlisted procedure, foot or toes
0707T	Injection(s), bone-substitute material (eg, calcium phosphate) into subchondral bone defect, including imaging guidance and arthroscopic assistance for joint visualization
0869T	Injection(s), bone-substitute material for bone and/or soft tissue hardware fixation augmentation, including intraoperative imaging guidance, when performed
L8699	Prosthetic implant, not otherwise specified

In‑office diagnostic arthroscopy codesCPTNot Covered

29805	Arthroscopy, shoulder, diagnostic, with or without synovial biopsy (separate procedure)
29860	Arthroscopy, hip, diagnostic, with or without synovial biopsy (separate procedure)
29870	Arthroscopy, knee, diagnostic, with or without synovial biopsy (separate procedure)
29999	Unlisted procedure, arthroscopy

Percutaneous ultrasonic ablation codesCPTNot Covered

20999	Unlisted procedure, musculoskeletal system, general
23929	Unlisted procedure, shoulder
24999	Unlisted procedure, humerus or elbow
25999	Unlisted procedure, forearm or wrist
26989	Unlisted procedure, hands or fingers
27599	Unlisted procedure, femur or knee
27899	Unlisted procedure, leg or ankle
28899	Unlisted procedure, foot or toes

Miscellaneous procedures (medial knee shock absorber, thermal capsulorrhaphy)CPT|HCPCSNot Covered

C8003	Implantation of medial knee extraarticular implantable shock absorber spanning the knee joint from distal femur to proximal tibia, open, includes measurements, positioning and adjustments, with imaging guidance (eg, fluoroscopy)
29999	Unlisted procedure, arthroscopy

References only — no codes listedmixed

No codes listed

Intra-articular corticosteroid injection frequency — maximums per rolling period and same-day limits

Rolling 12-month maximumMaximum of four intra-articular corticosteroid injections into the same joint during any rolling 12‑month period.

Same-day maximumNo more than two intra-articular corticosteroid injections administered on the same day to the same joint.

Applicable codesApplies to arthrocentesis/injection CPT codes 20600, 20604, 20605, 20606, 20610, 20611.

Suggested graft size applicability — suggested allograft/autograft size guidance

Allograft size guidance

Provider Responsibilities & Prior Authorization

Prior Authorization

Prior Authorization May Be Required

Prior authorization requirements vary by plan and may be required based on the member's specific benefit document. Providers should verify the applicable Cigna plan terms and obtain prior authorization when the member's benefit plan requires it.

Prior authorization requirement depends on the applicable benefit plan document and line of business.

Prior Authorization

Prior Authorization Recommended for Osteochondral Transplant

Prior authorization is recommended for osteochondral transplant procedures involving the talus (allograft or autograft) due to variable outcomes and evidence limitations; documentation should demonstrate failure of nonoperative management and prior arthroscopy when applicable.

Obtain prior authorization for talus osteochondral grafting (allograft or autograft) where the plan requires prior authorization.
Clinical documentation should include prior nonoperative management and prior arthroscopy when applicable, lesion size/location, and rationale for graft choice.

Clinical Background

Articular cartilage defects can produce pain, effusion, and mechanical symptoms and the tissue has limited intrinsic healing capacity. Autologous chondrocyte implantation (ACI) and osteochondral autograft/allograft strategies are established treatment approaches in the knee, but evidence supporting their use in other joints is limited; MACI/Carticel are FDA‑cleared for symptomatic full‑thickness knee defects, while effectiveness in other joints and in older patients is not established.

Definitions and Terms

Autologous chondrocyte implantation (ACI) — definition and context

DefinitionAutologous chondrocyte implantation (ACI) is a tissue‑engineering procedure in which a patient’s own chondrocytes are harvested, cultured, and implanted into a cartilage defect to regenerate articular cartilage and improve joint function.

Alternate nameAlso referred to as autologous chondrocyte transplantation (ACT).

Clinical contextProcedure aims to repair full‑thickness cartilage defects because articular cartilage has poor intrinsic healing capacity and defects cause pain, effusion, and mechanical symptoms.

Osteochondral autograft (mosaicplasty/OATS) — definition

DefinitionOsteochondral autograft (mosaicplasty/OATS) involves harvesting viable hyaline cartilage and underlying bone from a non‑weightbearing region of the patient’s joint and transplanting cylindrical grafts into a cartilage defect to restore the articular surface.

Policy Revision History

2025-04-15Annual Review - revisedLatest

Revised policy statement for the healing response (microfracture) technique.

2025-04-15Annual Review - removed

Removed policy statement for subacromial balloon spacer.

2024-07-15Focused Review - added

Policy Summary

PayerCigna

PolicyMiscellaneous Musculoskeletal Procedures

Policy CodePolicy 0515

Change TypeMaterial revisions (2024–2025): added thermal shrinkage & MISHArevised healing responseremoved several prior statements

Effective Date

Next Review DateApr 15, 2025

SourceLink

On This Page

Allografts are suggested for larger defects (authors recommend use for defects > 2.5 cm and dowel grafts may be applicable to lesions up to 35 mm).

Autograft size guidanceSurgeons generally restrict autograft use to lesions less than 2 cm due to donor-site volume limitations.

Graft form considerationsOsteochondral allografts may be dowel (cylindrical) or shell grafts; shell grafts are not limited by size or shape and may require fixation.

Intra-articular corticosteroid injection frequency (duplicate source) — <= 4 injections per rolling 12-month period and <= 2 injections same day

Rolling 12-month maximum<= 4 intra-articular corticosteroid injections per rolling 12‑month period to the same joint.

Same-day limit<= 2 injections to the same joint on the same day.

Policy applicabilityLimits apply to treatment of chronic osteoarthritic joint pain and reference specific arthrocentesis/injection CPT codes.

Prior Authorization

Prior Authorization Expectation for Listed Experimental/Unproven Codes

Procedures billed with the CPT/HCPCS codes listed in the policy Appendix as Experimental/Investigational should be submitted for clinical review and prior authorization where the member's benefit plan requires prior authorization; use of these codes may trigger review or denial.

Codes mapped to subchondroplasty, in‑office arthroscopy, percutaneous ultrasonic ablation, thermal shrinkage, xenograft/meniscal scaffold, MISHA, and related unlisted/product codes are considered experimental/investigational in this policy.
Claims using these codes may require prior authorization and supporting documentation to justify medical necessity; absence of documentation may result in denial.

Note

No New Authorization Directives in This Section

This Provider Actions section of the policy contains advisory content and code lists but does not itself establish new prior authorization program rules; prior authorization applicability is determined by the member's benefit plan and utilization management programs.

No standalone authorization directive is specified solely within this section — check the member's benefit plan for program-specific PA rules.
Revision notes and literature references in this section do not by themselves change PA requirements.

Denial Risk

Decellularized Allograft Failure Risk

Decellularized osteochondral allografts have reported high early failure rates in the published literature; providers should document device/product selection rationale and be aware that claims may be denied based on poor clinical evidence.

Reported failure rates (e.g., ~72% failure within 2 years in one retrospective series) should be considered when evaluating suitability of decellularized allografts.
Document expected benefits and alternative options; include literature or rationale when submitting for prior authorization or clinical review.

Denial Risk

Meniscal Scaffold Evidentiary Insufficiency

Evidence for meniscal scaffolds/implants is limited and does not consistently demonstrate improved health outcomes; use may be denied or require coverage review in the absence of supporting clinical evidence.

Long‑term safety and efficacy data are sparse; policy considers many xenograft/meniscal scaffold applications investigational.
Provide detailed documentation of prior treatments and rationale if requesting authorization for meniscal scaffold procedures.

Denial Risk

Subchondroplasty – Limited Evidence and Denial Risk

Subchondroplasty is considered investigational due to limited, low‑quality evidence; claims using associated codes may be denied without adequate supporting clinical evidence.

Current literature consists primarily of small case series and low‑quality studies with limited follow‑up.
Codes commonly associated with subchondroplasty (e.g., 0707T, 0869T, L8699, unlisted CPTs) are listed as experimental/investigational and may trigger denial if submitted without strong clinical justification.

Denial Risk

Miscellaneous Procedures Denial Risk

Certain miscellaneous procedures (for example, MISHA™ medial knee implanted shock absorber and arthroscopic thermally‑induced capsulorrhaphy) are considered experimental/investigational and may be denied when billed with the listed codes.

MISHA™ Knee System (C8003) is listed as experimental/investigational in this policy.
Thermally‑induced capsulorrhaphy procedures billed with unlisted arthroscopy codes (e.g., 29999, S2300 crosswalk) are considered investigational and may be denied.

Documentation Required

Regulatory Status Documentation

Regulatory status and device history should be included in clinical documentation when relevant. Document FDA clearances/approvals, rescissions, or special designations (e.g., De Novo, Breakthrough) that pertain to the device or product used.

Note FDA rescission of Menaflex™ and De Novo clearance information for MISHA™ when applicable.
Include device/manufacturer, regulatory pathway, and any known post‑market evidence in the prior authorization submission.

Billing Rule

Coding Currency and Documentation

Code lists in the policy may not be all‑inclusive and are subject to AMA/CMS updates. Providers must bill using current, effective CPT/HCPCS codes and include sufficient clinical documentation to justify services billed with listed or unlisted codes.

Deleted or non‑effective codes at time of service may not be eligible for reimbursement.
Confirm code currency and include detailed operative and pre/post‑operative documentation when submitting claims or prior authorization requests.

Note

References Present for Clinical Support Only

This section includes bibliographic references that support the clinical content of the policy. References do not, by themselves, create prior authorization rules or coverage determinations.

Use the cited literature to support clinical rationale in authorization requests but rely on the member's benefit plan and clinical criteria for coverage decisions.

Note

Revision History Present — No PA Procedures Specified

The Revision Details in this section provide a record of policy updates (dates and summary of changes) and do not include operational prior authorization program rules; verify plan-level PA requirements separately.

Revision history lists policy changes (e.g., added statements for MISHA, thermal shrinkage) but does not itself establish PA processes.
Check payer-specific utilization management portals or clinical review guidelines for PA submission instructions.

Prior Authorization

ACI Considered Second‑Line — Prior Conservative/Arthroscopic Management Expected

Autologous chondrocyte implantation (ACI) is regarded as a second‑line treatment for select femoral condyle lesions after failure of conservative and arthroscopic management; prior nonoperative care and prior arthroscopy are expected prerequisites when seeking authorization.

ACI (including MACI®) is restricted to carefully selected symptomatic adults with focal femoral condyle defects who have had inadequate response to prior arthroscopic or other surgical repair.
Document prior conservative therapies, prior arthroscopy, and age/lesion characteristics when requesting authorization.

Prior Authorization

Conservative Therapy First — Document Prior Nonoperative Management

Conservative (nonoperative) therapies are the standard initial management for most joint conditions addressed in this policy. Prior conservative treatment should be documented before authorization of advanced surgical or device‑based interventions.

Conservative measures include activity modification, physical therapy, bracing, medications, and weight management as appropriate.
Document duration and response to nonoperative care when submitting for prior authorization or clinical review.

Step Therapy

No Step Therapy Requirements Listed in This Section

No step therapy program requirements or specific step‑therapy rules are contained in this Provider Actions section; verify the member's benefit plan for any applicable step therapy or utilization management protocols.

This policy's references and revision history do not list step therapy rules.
Step therapy applicability is determined by the member's plan documents and utilization management programs.

Forms include mosaicplasty (multiple cylindrical grafts) and OATS (single larger plug).

Donor site and indicationsDonor sites commonly include the trochlea and intercondylar notch; primarily used for small to medium focal defects of the knee but also described for ankle, patella, elbow and tibia.

Osteochondral autograft (mosaicplasty/OATS) — alternative phrasing/definition

Alternate phrasingTransplantation of viable hyaline cartilage and bone harvested from non‑weightbearing sites of the patient into a cartilage defect via multiple cylindrical grafts (mosaicplasty) or a larger single plug (OATS).

Procedure notesRecipient tunnels are sized and grafts placed by press‑fit; donor sites typically fill with cancellous bone and fibrocartilage over weeks.

Advantages/limitationsAdvantages: no disease transmission, single‑stage; Limitations: donor‑site morbidity and limited graft volume for large defects.

Osteochondral allograft — definition and typical indications

DefinitionOsteochondral allograft transplantation uses cadaveric osteochondral tissue (dowel or shell grafts) to replace damaged articular cartilage and subchondral bone, preserving graft viability when implanted fresh.

IndicationsOften used for larger defects where autograft volume is insufficient; shell grafts can match defect contour and may require fixation.

Clinical considerationsAllografts avoid donor‑site morbidity but sizing and cellular viability (fresh implantation preferred) are important for outcomes.

Minced juvenile cartilage allograft (DeNovo NT/ET) — definition

DefinitionMinced juvenile cartilage allograft (eg, DeNovo NT/ET) consists of particulated juvenile articular cartilage containing living cells that are implanted (typically mixed with fibrin glue) to fill cartilage defects and encourage repair.

Regulatory statusDeNovo NT is registered as a minimally manipulated allograft tissue and listed on FDA HCT/P; evidence for long‑term safety and efficacy is limited.

Technique noteImplantation is a single‑stage procedure using juvenile donor cartilage to facilitate cell migration and matrix contribution to repair.

Meniscal scaffold / collagen meniscal implant — definition and device history

DefinitionMeniscal scaffold / collagen meniscal implant is a resorbable scaffold intended to reinforce and promote meniscal fibrocartilage regeneration (example: Menaflex).

Regulatory/device historyMenaflex initially received FDA 510(k) clearance for medial meniscus use but its clearance was later rescinded by the FDA due to differences from predicate devices.

Clinical concernsEvidence shows limited regenerative potential and variable outcomes; some scaffolds have uncertain long‑term effectiveness.

Subchondroplasty — definition of procedure

DefinitionSubchondroplasty is a procedure in which a bone void filler is injected into a subchondral bone marrow lesion under imaging guidance (eg, fluoroscopy) aiming to improve structural integrity and prevent collapse.

Intended goalIntended to fill bone defects so that the filler is replaced by bone and to reduce progression to collapse or osteoarthritis.

Evidence summaryCurrent evidence is low quality (case series, short‑ to mid‑term follow‑up) and insufficient to establish safety and efficacy across joints.

Percutaneous ultrasonic ablation (tenotomy) — definition

DefinitionPercutaneous ultrasonic ablation (tenotomy) uses a minimally invasive, ultrasound‑guided needle probe that applies ultrasonic energy to fragment, emulsify and aspirate degenerative soft tissue (eg, tendinopathy).

Device exampleAn example system is the Tenex Health TX System, which received FDA 510(k) clearance; 510(k) clearance does not by itself establish clinical effectiveness.

Procedure stepsProcedure involves ultrasound localization, probe insertion under guidance, ultrasonic fragmentation of diseased tissue, irrigation/aspiration and probe removal.

In-office diagnostic arthroscopy — definition and examples

DefinitionIn‑office diagnostic arthroscopy is a minimally invasive needle arthroscopy performed under local anesthesia in the office to visualize intra‑articular pathology as an alternative to MRI or standard surgical arthroscopy.

Device examplesExamples of FDA‑cleared systems include Mi‑Eye2™ and VisionScope® which provide illumination and visualization via a hand‑held sheath and tablet/monitor interface.

Evidence limitsMost published evidence is for the knee; overall high‑quality data on safety and impact on outcomes across joints are lacking.

MISHA (Medial Implanted Shock Absorber) — definition and intended effect

DefinitionMISHA (Medial Implanted Shock Absorber) is a subcutaneous, extra‑articular mechanical implant placed medial to the knee to offload the medial compartment and reduce intra‑articular loads.

Intended effectDesigned to improve symptoms of medial compartment osteoarthritis in patients unwilling or ineligible for total knee arthroplasty by absorbing load across the joint.

Regulatory status and evidenceReceived FDA De Novo authorization (DEN220033) in April 2023, but peer‑reviewed evidence is limited and longer‑term effectiveness remains uncertain.

Thermal shrinkage (arthroscopic thermal capsulorrhaphy) — definition

DefinitionThermal shrinkage (arthroscopic thermal capsulorrhaphy) uses radiofrequency or electrosurgical/electrothermal probes to apply non‑ablative heat to capsular, ligamentous, or tendon tissue to denature collagen and induce tissue shrinkage for purported tightening and stability.

MechanismHeat causes collagen denaturation and fiber shortening; effect depends on energy level, duration, tissue type and device used.

Synonymous terms/devicesAlso referred to as electrothermal arthroscopic capsulorrhaphy (ETAC); several thermal probe systems have FDA 510(k) clearance (eg, Oratec ORA‑50, VULCAN EAS, VAPR TC).

Thermal shrinkage — electrosurgical/electrothermal probe description

Probe descriptionElectrosurgical/electrothermal probes cleared via FDA 510(k) (eg, Oratec ORA‑50, VULCAN EAS, VAPR TC) are Class II electrosurgical devices used to deliver controlled thermal energy intra‑articularly.

Clinical roleProbes deliver non‑ablative heat intended to shrink collagenous tissue; reported complications include capsular necrosis, chondrolysis, nerve injury and recurrent instability when overheating or inadequate shrinkage occurs.

LimitationsDevice clearance does not imply demonstrated long‑term clinical efficacy for thermal shrinkage indications.

Electrothermal arthroscopic capsulorrhaphy (ETAC) — synonymous term

Synonymous termElectrothermal arthroscopic capsulorrhaphy (ETAC) is a synonymous term often used for arthroscopic thermal shrinkage, particularly in shoulder applications.

Clinical trial evidenceRandomized and multicenter trials and case series exist but report high failure rates in some cohorts (eg, ACL thermal shrinkage trials), limiting support for routine use.

Usage noteOften reported in literature alongside other thermal/energy‑based techniques for capsular tightening; long‑term benefits unproven.

subchondroplasty — alternate definition entry

Alternate definitionSubchondroplasty described as injection(s) of bone‑substitute material (eg, calcium phosphate) into subchondral bone defects including imaging guidance and possible arthroscopic assistance, intended to treat bone marrow lesions or microtrabecular fractures.

Codes referencedProcedure descriptions reference codes such as 0707T and 0869T for injections of bone‑substitute material into subchondral defects.

Evidence contextSystematic reviews conclude evidence is low quality and insufficient to determine net health benefit.

in‑office diagnostic arthroscopy — alternate definition entry referencing Mi‑Eye2™, VisionScope®

Alternate definitionIn‑office diagnostic arthroscopy refers to small‑bore, in‑office arthroscopic evaluation (example devices: Mi‑Eye2™, VisionScope®) performed under local anesthesia and reported with diagnostic arthroscopy CPT codes or unlisted arthroscopy codes.

Device examplesMi‑Eye2™ and VisionScope® are cited as examples of systems used for in‑office needle arthroscopy.

Coding noteReported using diagnostic arthroscopy codes (29805, 29860, 29870) or unlisted arthroscopy code (29999) depending on joint and documentation.

percutaneous ultrasonic ablation — alternate definition entry

Alternate definitionPercutaneous ultrasonic ablation is a minimally invasive procedure employing an ultrasound‑guided probe that uses ultrasonic energy to fragment, emulsify and aspirate degenerative soft tissue in tendinopathies.

Regulatory noteThe Tenex Health TX System is an example device cleared by the FDA via 510(k); such clearance does not require evidence of clinical effectiveness prior to marketing.

Evidence summaryLiterature is primarily case series and small studies with limited follow‑up; comparative evidence is lacking.

Subchondroplasty — literature-cited definition and context

Literature‑cited definitionSubchondroplasty is described in systematic reviews and clinical series as injection of bone‑substitute material into bone marrow lesions in osteoarthritis with short‑ to mid‑term follow‑up and limited evidence for safety and efficacy.

Evidence sourcesSystematic review citations (eg, Nairn et al., 2021) and multiple small series are referenced to characterize limited quality evidence.

Clinical implicationAuthors conclude higher‑quality, long‑term studies are required to establish net health benefit.

Mosaicplasty / Osteochondral Autograft Transplantation — literature-cited definition and context

Literature‑cited definitionMosaicplasty / osteochondral autograft transplantation is documented in multiple long‑term cohort and comparative studies for talus, knee, capitellum and other joints; literature includes reviews and technique descriptions (eg, Mendicino 2001; NICE guidance IPG607).

Clinical evidenceReferences include systematic reviews and meta‑analyses comparing allograft versus autograft for talus and outcomes of mosaicplasty across joints.

Technique summaryProcedure involves harvesting cylindrical bone‑cartilage grafts and press‑fit transplantation into recipient tunnels with donor sites healing over weeks.

Added policy statement for thermal shrinkage (arthroscopic thermal capsulorrhaphy).

2024-04-15Annual Review - added/removed

Added policy statement for medial knee implanted shock absorber and removed statements for focal resurfacing of the knee joint and allograft bone substitutes for isolated facet fusion.